What’s it like to work with those Great Investigators?

Beats the hell out of me–I never really worked with them. Not that that´s a problem–from the small number of them whom I did meet, I was, well, res ipsa loquitor.

The Beginning

It was my first visit to the country of S, before I had my Masters in Public Health. I was going to work on a project involving a certain disease, known locally as Eeeeeee, prevalent in the Ccccccc area. I had a training a grant a professor had helped me obtain, and I studied up on what I thought I would be doing while I left my family for seven weeks (not a popular decicision) and went to work with people I didn´t know, in a country I had never visited, with an understanding of a language that on a good day could be described as rudimentary. You have to understand that other than leaving my family, all of the aforementioned I considered good things. New country? New knowledge? New people? What a change from the rut of the routine that I had worried would characterize the rest of my professional life, which, given how young my kids are and how much university education is going to cost, appeared (and still appears) to be a long, long time.

The Professor and I had discussed what I was going to do. I was going to examine the role of domestic animals in the movement of disease and its vectors. I was to work with an biostatistician who had published a lot of papers on the epidemiology of the disease and was head of the project down there. There was also a scientist from ?/?, who had very clear ideas of the way pretty much everything in the world should work. She also holds the distinction of being one of the top five rudest people I’ve ever met in my life.

First Lesson Learned?

In retrospect, I should have gone to meet these people before I went down there. Or maybe it should have been explained more clearly what sort of control they were to have over what I was doing. I was a neophyte in these manners. I had spent the last 15 or so years treating animals for the diseases and conditions that they had. I had only finished my coursework for my MPH a couple of months before. I have to admit to not knowing exactly how these things worked. But I had–and still have–enormous trust in both the knowledge and intentions of the Professor.

and I reach in a pull off the first tick of the season. I marked it on my calendar, and planned my annual The-Ticks-Have-Returned-It-Must-Be-Spring celebration. I placed the tick in a plastic cup with some 91% alcohol so I could identify it when I’m not busy writing these (insert adjective or expletive) grant proposals. But then the hyper-efficient nanny threw it out when she came in, before I even had a chance to play with it.

I’d make a posting, but I’m too damn panicked for a grant deadline on Wednesday.

Ain't too proud to beg

That’s how it works, folks. Scientists, artists, etc, get ideas, and then we spend hours of unpaid time putting together an elaborate appeal for cash. If the grantors are suitably impressed, we get to go forward, for a limited amount of time.

A Tale of Two Tails?

So we are out behind the restaurant in the courtyard, and I am preparing to give this kitchen worker an injection in his ass. Mario, the hotel owner, has asked me to do it so that the worker–forgive me, having stuck a needle in someone’s derriere I should at least have the courtesy to remember his name, but for the life of me I don’t, maybe there was a selective amnesiac in that pisco sour I drank–so that the worker will not have to trudge all the way over to the local Puesta del Salud, or health post. Time is money, you know, and for most of Peru, it seems to be in short supply.

Rosemary keeps telling me “If it makes you uncomfortable, don’t do it.” She doesn’t mean dealing with a stranger’s naked buttocks, she thinks that sometime later this year my patient is going to get a boil the size of a bocce ball back there, which will land the patient in the hospital and me in court. Liability, shmiability, I scoff internally, and give the guy his medicine.

Two days later. . .

I am at Rosemary’s house/La Asociación Humanitaria “San Francisco de Asis”, and my patient walks by. He says hello to me, and I greet him in return. He clearly desires to talk to me. With my inadequate Spanish, I learn his story.

He is being sent home descansar–to rest–for a few days. Why? Well, his illness requires it. What, I ask, exactly is the problem? I get a picture of something that has been going on for a few weeks, something that seems to give him some headaches and some vision problems. Hmmm, I wonder, without saying anything, other than the obvious have you been to a doctor? Oh, yes, he says, but I am very poor, he says. I show more consternation on my face–it’s easier than trying to ask detailed questions, and after all, I’m not a physician. I ask him what the doctor said. She said it was my riñones–kidneys–because I have some back pain as well. Did she do any tests, I ask? I am very poor, he says. Did she take any blood, do any x-rays? He repeats that he is too poor. I am wondering if he is having migraines, or something even more serious. Couldn’t she refer you to the hospital in Paita (which is only 15-20 minutes and less than a dollar away)? Again, the poverty.

I know he wants money from me. He doesn’t ask, but the refrain of pobre is too constant, too supplicatory to be mistaken for something else.I’m usually a pretty soft touch, but I don’t want to give in. I don’t understand this situation, my pocket is strained right now, my time in Peru is unpaid, and if what he says is true then what he really needs is for me to take him to a doctor myself, and see that he is getting his symptoms looked at properly.

I wish him good day and turn away. He walks off to his home. I go in the house and Rosemary asks what he wanted. I tell her the story. Oh, she says matter-0f-factly, he was asking you for money, as if it were an everyday occurrence. And they always say that it’s the riñones here, she adds. Your head hurts, your stomach aches, you’ve got leg problems, it’s the riñones. Rosemary has had some labor problems lately, and the money issues have her worried as well.

Okay, so who’s tail number two?

Yes, I said that this was a tale of two tails. My patient doesn’t have access to health care, and it’s so easy to rail against the social injustice of it all. (Peru does have a national health plan, but it isn’t adequate.) But then I get home, and our government can’t make sure that we all have access to adequate health care. Two weeks later the news hits the stand that premiums are far outpacing inflation. Some Californians will see an increases of around 40%. For people of my home state–Illinois, Land of Lincoln and insurance company’s paradise–the situation is far worse than where I live now, in Massachusetts. But we, the bluest of the blue, just elected a Cosmo centerfold whose promise was that he would be the “41st vote against” health-care reform.

Shot in the Ass

On my first night in Colan, during my recent trip to Peru, I went down the road to have dinner at the Colan Beach Lodge. It’s the nicest place on the beach, but still nothing fancy. The owner, Mario, is friends with Rosemary, the director–or basically the whole staff–of the Asociacion Humanitaria San Francisco de Asis. Prior to dinner, Rosemary asked me to administer some deworming medication to Mario’s dogs, and Mario asked me to administer some medication–injectable medication–to one of his employees.

Rosemary was worried that I would incur some sort of liability, and at first I was inclined not to do it, but then I realized that it was both unlikely that an adverse event (in other words, a bad side effect or some harm due to the shot) would occur, or even if it did, I doubted that I could even be found to get dragged into whatever South American mess might ensue.

What the employee suffered from, I couldn’t say. The injection was a combination of Vitamin B and a dexamethasone, a corticosteroid. I think that there was some lidocaine in there as well, presumably to dull the pain of the a deep intramuscular injection. It seemed a particularly un-American injection. Not that it would have appeared before a Michele Bachman commision, should she have gotten her wish to carry on the tradition of fellow Midwesterner Joseph McCarthy, but vitamin B injections, as well as corticosteroids for general undiagnosed pain, just aren’t used that much in these parts. However, whenever I’ve been around veterinary practices outside of the United States, it seems that a bit of the yellow (the color of vitamin B) is always added to the fluid therapy when IV fluids are used, and injected otherwise when they aren’t.

So I gave the guy his shot. What the hell, I figured, I’d get a free pisco sour out of it.

1962: A hopeful Mastroianni and Loren discuss their hopes and wishes for a Chagas' -Free world before Marcello dies. Alas, Marcello did not live to see that day, but apparently, Ms. Loren has every intention of doing so.

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An Online Journal of Chagas’ Disease, Rabies, Beverages from South America, Dishes from the Sixties, and Other Public Health Issues

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We do not wish to diminish the importance of Chagas' disease, or make it seem that we are equating its significance with that of Pisco Sours or Inca Kola--we realize, alas, that for the most part only geeks and do-gooders are interested in diseases like Chagas'. We are hoping that by including matters of interest to the general public that we may attract more readers.

Richard Lerner

Richard Lerner is the author of this blog. All complaints should be sent to anyone other than him. We are looking for other writers interested in vector-borne disease, or timely information on the fight against these conditions, especially in the Americas.